A better way to treat early breast cancer
It wasn’t long ago that women diagnosed with breast cancer had to endure disfiguring surgery in order to survive. Now, thanks to advances in both treatments and oncoplastic surgery, there is no longer a need to bargain one for the other.
One recent advance in the way early stage breast cancer is being treated is with Biozorb, an innovative implant that is placed in the breast during a lumpectomy to mark the site for future radiation, if necessary. This allows for more focused radiation and better follow-up imaging. At the same time, it serves as a platform for new tissue growth. Used during breast conservation surgery, or lumpectomy, the cosmetic benefit is usually a fuller, more natural looking breast.
About the size of a walnut, Biozorb looks like a coil with six titanium clips attached around each circumference.
And, for anyone worried about introducing an implanted device into their body, Biozorb is made of digestible materials, which will eventually be resorbed over time. The clips remain in place.
Hyannis breast surgeon Kathryn Dalton, DO, FACS, first learned about Biozorb two years ago when she was receiving her training and certification from the School for Oncoplastic Surgery in Dallas, Texas.
“The surgeons there were using it and were telling me that it was the newest, greatest thing. So after getting my certification, I really began to adopt it,” she said. Her colleague, breast surgeon Jill Oxley, MD, uses it as well.
Targets More Precisely
Radiation treatment is a standard protocol after lumpectomy and is used after surgery to kill any lingering microscopic cancer cells. Planning where to aim the beam was a challenge before this device came along. The Biozorb marker allows radiation oncologists to target the radiation more precisely said Dr. Dalton.
“Before Biozorb, surgical marking looked haphazard on imaging afterwards,” she said. Clips were hand placed, but they didn’t always provide a clear view of the surgical site and the margins.
“We do so much tissue rearrangement after removing the cancer, it makes it hard for the radiation oncologists to determine exactly where to focus the radiation treatments,” said Dr. Dalton. “But now, with the Biozorb, it leaves a three dimensional foot print of the surgical site so the margins are clearer. Radiation can be boosted in a more targeted area, sparing healthy tissue. It is also much easier to follow on imaging moving forward.”
On the surgical side, the device provides some added advantage of acting like a scaffold for rearranged tissue. It also puts a little volume back into the breast that was lost in the lumpectomy and it does help preserve the shape and contour of the breast.
“There are different sizes and we always try to use the smallest one possible,” said Dr. Dalton.
All surgery carries some risk, and implanted devices have an added threat of infection. But, in the hundreds of patients Dr. Dalton has treated using Biozorb, there were only two that needed to be removed. And one was precautionary.
“In this particular case, the patient had clean margins but I wanted bigger margins,” said Dr. Dalton. “And I had done a lot of tissue rearrangement. If I have to go in a second time, I don’t like to leave implants in. My gut told me to take it out.”
Who’s a Candidate?
Most women with early stage breast cancer, for whom lumpectomy is possible, are candidates for the device, Dr. Dalton said. There are two exceptions, however. Obese diabetic smokers are precluded because they are at higher risk of infection. And women with the surgical site too close to the skin surface are also ineligible.
“You are supposed to have about two centimeters of breast tissue on top of it for it to work properly,” said Dr. Dalton.
It is anyone’s best guess as to when the Biozorb will be completely absorbed into the body. Focal Therapeutics, the medical device company that developed it, claims that it can take a year or more. Dr. Dalton does have a handful of patients that have experienced that length of time, even some who are two years post-surgery.
And some small-breasted women complain that they can feel the device when touching their breast. Feeling any palpable lump near a surgical site can cause distress and alarm. Dr. Dalton spends a lot of time preparing her patients for this possibility to allay any fears.
“You don’t want them going to their primary care provider with worry and having them order unnecessary imaging. You have to let the patient know ahead of time to create a proper expectation.”